14-year-old male patient with twisting injury

Case
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14-year-old male injured his elbow during a football game with a twisting type injury. Patient is experiencing pain along the medial side.

Long- and short-axis fat- and water-weighted images were performed. 

  • Evaluation of the osseous structures reveals osseous edema within the olecranon ossification center. Edema and T1 hypointensity at the coronoid process with suggestion of a tiny cortical irregularity concerning for a small chip fracture. Osseous edema and subtle T1 linear hypointensity involving the posterior capitellum consistent with a microtrabecular fracture and cortical irregularity with contralateral fracture of the anterior superior radial head suggesting dislocation event.  
  • No substantive arthropathic change. Moderate size mildly complex joint effusion suggesting a component of hemarthrosis. 
  • Biceps tendon is intact. The inferior margin of the lateral head and long head at the triceps brachii tendon demonstrates a striated appearance with inferior wavy fibers suggesting grade 1-2 muscle injury. The anconeus also demonstrates interstitial edema extending from the level of its insertion with a few subtle wavy fibers involving 25 to 50% of the anterior anconeus muscle consistent with a grade 2-3 muscle injury.
  • Partial thickness tearing at the origin of the extensor carpi ulnaris. Mild tendinosis involves the remainder of the common extensor tendons. Insertional edema at the origin of the common flexor tendons. 
  • Interstitial edema and a striated appearance with wavy fibers involving the medial aspect of the brachialis with a prominent defect of the most medial fibers with interstitial fluid and mild macro-retraction consistent with a grade 2-3 muscle injury. Partial thickness tearing and a mildly striated appearance at the origin of the pronator teres humeral head and flexor carpi ulnaris (ulnar head) consistent with a grade 1-2 muscle injury. Interstitial edema and wavy fibers involving the flexor digitorum superficialis humeral ulnar head consistent with a grade 2 muscle injury.
  • No evidence of mass cyst or ganglion. The median nerve demonstrates mild hyperintensity as it passes deep to the pronator teres humeral head with surrounding edema and hemorrhage from brachialis muscle injury.  
  • Avulsion of the anterior band of the ulnar collateral ligament from its proximal insertion upon the medial epicondyle of the humerus. Full thickness complete mid substance tear of the posterior band of the ulnar collateral ligament.
  • Mild insertional signal of the radial collateral ligament at the humeral head suggesting low grade sprain; however the fibers appear intact. Lateral ulnar collateral ligament is also intact. Annular ligament appears intact.
  • Mild hyperintensity of the median nerve as it crosses through the region of hemorrhage and edema associated with the brachialis muscle tear. Mild hyperintensity of the ulnar nerve as it courses through the cubital tunnel.

Elbow valgus dislocation with Osborne Cotterill lesion of the humerus amd proximal MCL rupture:

  • Avulsion of the proximal humeral attachment of the anterior band of the ulnar collateral ligament as well as a mid substance tear of the posterior band and swollen/injured transverse band of the ulnar collateral ligament. Low grade sprain of the radial collateral ligament. 
  • Microtrabecular fractures of the posterior capitellum anterior superior radial head and coronoid process with subtle cortical irregularity at coronoid and capitellum suggesting dislocation event with possible chip fracture. Correlation with CT may be of benefit. 
  • Diffuse muscular injury predominantly grade 1-2 strains with mild wavy fibers involving the lateral and long head of the triceps brachii flexor digitorum superficialis humeral head of the pronator teres and flexor carpi ulnaris (ulnar head). Grade 2-3 muscle injuries with mild macro-retraction hematoma surrounding edema and involvement of the myotendinous junction of the anconeus and brachialis.  
  • Olecranon apophyseal stress reaction without displacement and associated edema and swelling of the triceps tendon. 
  • Mild hyperintensity of the median nerve as it crosses through the region of hemorrhage and edema associated with the brachialis muscle tear. Mild hyperintensity of the ulnar nerve as it courses through the cubital tunnel.

Related Diagnoses

Diagnosis Definitions

Ulnar Collateral Ligament (UCL) tear

Diffuse muscular injury, Transverse bundle, Elbow, MSK, UCL avulsion,